Provider Demographics
NPI:1992072474
Name:RONALD ACCOMAZZO, MD, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:RONALD ACCOMAZZO, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ACCOMAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-993-9824
Mailing Address - Street 1:18350 ROSCOE BLVD
Mailing Address - Street 2:SUITE 318
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4109
Mailing Address - Country:US
Mailing Address - Phone:818-993-9824
Mailing Address - Fax:818-993-0937
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 318
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-993-9824
Practice Address - Fax:818-993-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18686174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89296Medicare UPIN